Death rates in care homes – a measure of quality?

Dr Eileen Burns is the recently elected BGS President Elect and is a Consultant Geriatrician at St James’s Hospital, Leeds.

 “My Mum no longer recognises me or my sisters. She needs help with everything- washing and dressing, eating and drinking. She is incontinent. If she could see herself like this she would be distraught. We were very relieved when her GP met with us to discuss what we felt she would have wanted for herself in this situation. We don’t feel that there is anything to be gained for her by another hospital admission- unless she has a problem which is causing her distress which they can’t alleviate here in the home. We’d like her to die here with the dignity she has left in the place and with the carers she’s familiar with”

The recent spotlight on increasing death rates in care homes accompanied by commentaries implying that this is an unwanted and regrettable development put a naive and simplistic gloss on a complex issue.

Understanding the lives of people living with frailty

To celebrate the launch on new guidance, Fit for Frailty, every day this week we have published a guest blog on aspects of frailty. Today’s article is from Tom Gentry (@TomoGentry) of AgeUK who is writing  from the perspective of older people who live with frailty. 

In April, we reported on the Government’s efforts to transform primary care, which set out a programme to deliver better coordinated, well-planned care for the most “vulnerable” people being supported by GPs.

The terms “frail” and “vulnerable” are often used interchangeably in this context. What is often lost is the person behind the terms and the things in their life that are making them “frail” or “vulnerable”.

The key to happy retirement… independence

Sarah Wallace, Head of Services at the Charity Crossroads Care CNL, talks about their Homeshare programme and how it is a scheme that helps older people keep their independence and remain in the home they love. 

I like to think that as I get older, I will be able to keep my independence.  But will increasing care costs mean that I’ll just struggle alone at home?  Recently, I met Felicity who has recently struggled with ill health, meaning that she has had to consider alternative ways to maintain her independence.  In this search, Felicity came across the new Homeshare programme which we run here at the charity Crossroads Care CNL.

Perfect match

The Homeshare scheme uses a ‘matching’ service which helped Felicity find someone to share her house with because her disabilities make it tough for her to live alone.  The Homeshare scheme has changed her life and that of her sharer.

BBC documentary series ‘Protecting our Parents’

Dr Peter Wallis, formerly consultant geriatrician – Birmingham Heartlands Hospital, was involved with the filming of a new BBC 2 Documentary Series

The department of elderly medicine at Birmingham Heartlands Hospital became aware of the BBC‘s interest in a documentary series about the care of older people following an advertisement in the British Geriatrics Society Newsletter (2012) placed by the BBC Bristol Documentary team.   The intention was to produce a 3 part documentary series reflecting current issues in the health and social care of older people. Following successful discussions and with the agreement of partner organisations including social services as well as primary, community, mental health and ambulance service teams, filming took place during 2012/13. Filming was centred around the elderly care and general wards as well as the A&E department at Birmingham Heartlands Hospital and the patients with their stories were followed into community settings.

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults

Laura Izzard is an Specialty Trainee in Geriatric Medicine at Kings College Hospital, London

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults – is a joint research initiative between Comic Relief and the Department of Health.

Published in December 2013, the PANICOA report ‘Respect and Protect’ draws together the findings of eleven individual research studies commissioned to examine the complex issue of mistreatment of older people in hospitals and care homes. It outlines three vantage points i.e. “narratives” reflecting the perspectives of residents and patients, care staff and care organisations. Themes emerging from the PANICOA Narratives were used by the authors to produce a number of recommendations intended to reinforce and/or improve current practice.

Year of Care Explained

By Eileen Burns and Amit Arora

Payment by results (PbR) never fully addressed the management of long term conditions, and the importance of timely and seamless transition to and from the community for patients who live with them.

Year of Care (YoC) was suggested as a possible solution in 2011 by Richard Murray, Chief Economist at the Department of Health in his document, “Payment reform in the NHS”. The long-term conditions YoC tariff is designed to allow health and social care to be provided based on a person’s overall needs as opposed to what specific diseases they have. It fits with the work being undertaken across the NHS to make care better integrated. If it works as intended, it will allow funding to be moved around as needed to provide the most effective ‘package’ of care for the person over a 12-month period. The underpinning philosophy is that money should be present in the parts of the healthcare system best-suited to provide patient care. The financial model is based upon an annual risk-adjusted ‘capitation’ budget, based on levels of health care need.

Avoiding Serial Projectitis – Making Health and Care Systems fit for an Ageing Population

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society. He writes on the King’s Fund blog about their paper, launched today.

By 2030, one in 5 people in England will be over 65 and at that age, men will on average live till 88 and women till 91. This population ageing shouldn’t constantly be catastrophised with language like “burden” “timebomb” or “tsunami”. In fact, it represents a victory for improved societal conditions and for modern healthcare – preventative and curative. Indeed, well into older age, most people report high levels of happiness, health and wellbeing and even over 80, only half say they live with life limiting long-term conditions.

However, despite the “upside” of population ageing, we need to be realistic about its inevitable implications for health and care services.

Who will care for the carers?

Sharon Xiaorong Wang is a  nurse researcher at the Center of Research on Aging, Jinan, Shandong, China and is the lead investigator for the Chronic Disease Self-Management Program at the Department of Gerontology, Jinan Central Hospital.

The association between chronic disease and carers of patients with dementia has been well described in the literature. Caring for patients with memory impairment can put a strain on the health [both physical and mental] of the care-giver. Up till now, the demographics and scale of chronic disease afflicting care providers have not been well explored. We have conducted a study to examine the prevalence of chronic disease in carers of patients with dementia.

Our results indicate that more than four-fifths of care-givers reported having at least one chronic disease, and nearly two-thirds reported multiple.

Costs of staffing for compassionate care

Nicky Hayes is Consultant Nurse for Older People, King’s College Hospital London, formerly RCN Older People’s Advisor 2011-12, author of Safe Staffing for Older People’s Wards

Nursing staffing issues, especially for hospital wards where older people are cared for, are complex and contentious and have not gone away since the RCN published Safe Staffing for Older People’s Wards and Improving Hospital Care for Older People – A Call for Action. These publications were the first to identify actual staffing levels specific to older people’s wards and to correlate these with nurses’ reports of whether satisfactory, safe care could be delivered during their most recently worked shift.

EASYCare Project: A new world for older people

 

Judith Long is a Project Officer in Research and Development at Hull and East Yorkshire Hospitals NHS Trust. Here she introduces a new collaborative project to promote independence  in older age.

EASYCare is a collaborative project involving a large network of researchers, service providers, practitioners, volunteers and age advocacy partners throughout the world. Our mission is to extend healthy active life and maximise independence in old age using the EASYCare targeted approach to early identification of needs, and by providing a response according to the priorities of the older person.